PAST ISSUES OF THE JOURNAL OF MANUAL AND MANIPULATIVE THERAPY

Neural Mobilization: A Systematic Review of Randomized Controlled Trials with an Analysis of Therapeutic Eficacy

Richard F. Ellis, B. Phty, Post Grad Dip, Wayne A. Hing, PT, PhD

Abstract: Neural mobilization is a treatment modality used in relation to pathologies of the nervous system. It has been suggested that neural mobilization is an effective treatment modality, although support of this suggestion is primarily anecdotal. The purpose of this paper was to provide a systematic review of the literature pertaining to the therapeutic eficacy of neural mobilization. A search to identify randomized controlled trials investigating neural mobilization was conducted using the key words neural mobilisation/mobilization, nerve mobilisation/mobilization, neural manipulative physical therapy, physical therapy, neural/nerve glide, nerve glide exercises, nerve/neural treatment, nerve/neural stretching, neurodynamics, and nerve/neural physiotherapy. The titles and abstracts of the papers identiied were reviewed to select papers speciically detailing neural mobilization as a treatment modality. The PEDro scale, a systematic tool used to critique RCTs and grade methodological quality, was used to assess these trials. Methodological assessment allowed an analysis of research investigating therapeutic eficacy of neural mobilization. Ten randomized clinical trials (discussed in 11 retrieved articles) were identiied that discussed the therapeutic effect of neural mobilization. This review highlights the lack in quantity and quality of the available research. Qualitative analysis of these studies revealed that there is only limited evidence to support the use of neural mobilization. Future research needs to re-examine the application of neural mobilization with use of more homogeneous study designs and pathologies; in addition, it should standardize the neural mobilization interventions used in the study.

The Journal of Manual & Manipulative Therapy Vol. 16 No. 1 (2008), 8-22

Invited Commentary - Michael Shacklock

[No abstract available]

The Journal of Manual & Manipulative Therapy Vol. 16 No. 1 (2008), 23-24

Three-dimensional Movements of the Sacroiliac Joint: A Systematic Review of the Literature and Assessment of Clinical Utility

Adam Goode, Eric J Hegedus, Philip Sizer Jr, Jean-Michel Brismee, Alison Linberg, Chad E Cook

Abstract: The high frequency of static and dynamic palpation methods used during evaluation of SIJ problems in clinical practice demands an understanding of the factual quantity of movement at the SIJ. The objective of this systematic literature review was to synthesize three-dimensional (3-D) motion of the sacroiliac joint (SIJ) during various functional static postures and movements and to determine the clinical utility of movement during examination. A computer-based search was performed by means of OVID, which included Medline (February 1966 to April 2007) and CINAHL (February 1982 to April 2007) using the key words Pelvis, Kinematics, Imaging, Three-dimensional, and Stereophotogrammetric. Articles included in-vivo or in-vitro studies that investigated human SIJs with 3-D analysis. Three-dimensional analyses conducted using mathematical modeling, computerized modeling, and/or skin markers were not included because of concerns of transferability and validity. Studies that failed to report standard error of measurement (SEM) or deined tabulated values for translations or rotations using the Cartesian coordinate system were not considered for this study. Studies included for review were analyzed by the SBC biomechanical checklist to measure the quality of procedural design. Seven manuscripts were eligible for inclusion in this study. Rotation ranged between -1.1 to 2.2 degrees along the X-axis, -0.8 to 4.0 degrees along the Y-axis, and -0.5 to 8.0 degrees along the Z-axis. Translation ranged between -0.3 to 8.0 millimeters (mm) along the X-axis, -0.2 to 7.0 mm along the Y-axis, -0.3 to 6.0 mm along the Z-axis. Motion of the SIJ is limited to minute amounts of rotation and of translation suggesting that clinical methods utilizing palpation for diagnosing SIJ pathology may have limited clinical utility.

The Journal of Manual & Manipulative Therapy Vol. 16 No. 1 (2008), 25-38

Manual Therapy and Cervical Arterial Dysfunction, Directions for the Future: A Clinical Perspective

Roger Kerry, MSc (Manipulative Therapy), PGCHE, MMACP, MCSP Alan J Taylor, MSc (Sports Medicine), MCSP Jeanette Mitchell, BSc (Physiotherapy), PhD, PGCert(HE), MCSP Chris McCarthy, PhD, MMACP, MCSP John Brew, MMACP, MCSP

Abstract: This paper offers a contemporary, evidence-based perspective on the issue of adverse neurovascular events related to cervical spine manual therapy. The purpose of this perspective is to challenge traditional thought and practice and to recognize areas where practice and research should develop. By considering the themes presented in this paper, the clinician can broaden his or her approach to neurovascular assessment in line with contemporary evidence and thought. We present information based on clinically relevant questions. The nature of vertebrobasilar insuficiency and the utility of pre- treatment testing are examined in light of contemporary evidence. In addition, we report on internal carotid artery pathology, and the signiicance of appreciating atherosclerosis in clinical decision-making. These later two areas are not commonly recognized within manual therapy literature, and we suggest that their importance to differential diagnosis of head and neck pain, as well as estimating treatment related risk, is paramount. We propose that the term cervical arterial dysfunction is more appropriate than classically used nomenclature. This term refers more accurately and completely to the range of pathologies at different anatomical sites that manual therapists treating patients with head and neck pain are likely to encounter. Finally, we present a brief review of the medico-legal status pertaining to this area. Although this is English law-related, the themes derived from this section are of interest to all manual therapists.
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The Journal of Manual & Manipulative Therapy Vol. 16 No. 1 (2008), 39-48

Invited Commentary - Janet Lowcock

[No abstract available]
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The Journal of Manual & Manipulative Therapy Vol. 16 No. 1 (2008), 49

A Model for Standardizing Manipulation Terminology in Physical Therapy Practice

Paul E. Mintken, PT, DPT, OCS, Carl DeRosa, PT, PhD, DPT, FAPTA, Tamara Little, PT, DMT, FAAOMPT, Britt Smith, PT, DPT, OCS, FAAOMPT for the American Academy of Orthopaedic Manual Physical Therapists.

Abstract: Research supporting the eficacy of manual therapy, manip- ulation in particular, is growing. The ability to communicate clearly and accurately regarding this important interven- tion, regardless of region or background, is essential if clini- cians are to incorporate this research in clinical practice. In February 2007, the American Academy of Orthopaedic Man- ual Physical Therapists formed a task force to standardize manual therapy terminology, starting with the intervention of manipulation. The ultimate goal of this task force was to create a template that has the potential to be used interna- tionally by the community of physical therapists in order to standardize manual therapy nomenclature. The following document relects the work and recommendations of this task force.
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The Journal of Manual & Manipulative Therapy Vol. 16 No. 1 (2008), 50-56

Inclusion of Mechanical Diagnosis and Therapy (MDT) in the Management of Cervical Radiculopathy: A Case Report

Ronald Schenk, PT, PhD, OCS, Cert MDT, FAAOMPT, Daemen College, Amherst, NY, Talisha Bhaidani, DPT, Daemen College, Amherst, NY, Melissa Boswell, DPT, Daemen College, Amherst, NY, James Kelley PT, Villa Maria College, Uniform Data Systems, Buffalo, NY, Timothy Kruchowsky, PT, FAAOMPT, Manual Therapy Institute, Cedar Park, TX

Abstract: Various interventions are used by physical therapists to treat neck conditions. Treatments may include exercises based on a direction of preference, cervical spine stabilization, neuromobilization, or traction. The purpose of this case study was to describe the use of mechanical diagnosis and therapy (MDT) in the management of a patient diagnosed with cervical radiculopathy. The case study involved a 39-year-old male (subject), classiied with cervical derangement, hypermobility, and adverse neural tension. The subject's intervention included MDT, deep neck lexor muscle strengthening, and neuro- mobilization. This subject's scores on the Neck Disability Index, Numerical Pain Rating Scale (NPRS), and range of motion were assessed at initial examination, discharge, and 3-month follow-up. The subject improved on all outcome measures and was discharged after four visits with a NPRS of 0/10. Percent improvement per visit was 17.5%. This case describes a positive outcome for a patient diagnosed with cervical radiculopathy in which MDT, deep neck lexor strengthening, and neuromobilization were used as an alternative to cervical traction.
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The Journal of Manual & Manipulative Therapy Vol. 16 No. 1 (2008), E2-E8

Intrinsic and Extrinsic Factors Important to Manual Therapy Competency Development: A Delphi Investigation

Phillip Sizer PT, PhD, OCS, FAAOMPT, Steven Sawyer, PT, PhD, Virginia Felstehausen, PhD, Sue Couch, PhD, Lanie Dornier, PhD, Chad Cook, PT, PhD, OCS, FAAOMPT

Abstract: A learner's development of orthopaedic manual physical therapy (OMPT) psychomotor skills may be inluenced by selected intrinsic and extrinsic factors. The purposes of this study were to identify the factors that inluence learners' development of manual physical therapy competencies and to deine each factor as intrinsic or extrinsic. A 3-round Delphi method survey and a retrospective review of the data were used to develop composite scores and rankings. Eighty manual physical therapy educators participated in the 3 rounds. Thirty-six factor descriptor statements associated with manual physical therapy competency were established and further categorized as intrinsic (19 total), extrinsic (10 total), or conceptual outliers (7 total). Cognitive Processing ranked as the most important factor inluencing manual physical therapy competency development. Adaptation ranked second, followed by Science Knowledge. This study is the irst to establish manual physical therapy educational factors associated with attainment of competency. The majority of the factors distill into the theory of extrinsic and intrinsic factors identiied by Schmidt and Lee. The outcomes of this study identify the factors to which OMPT educators should give particular attention when developing and executing the learning experiences for their learners.
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The Journal of Manual & Manipulative Therapy Vol. 16 No. 1 (2008), E9-E19

American Academy of Orthopedic Manual Physical Therapy (AAOMPT): History, Advocacy, and Education

Kenneth A. Olson PT, DHSc, OCS, FAAOMPT

[No abstract available]
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The Journal of Manual & Manipulative Therapy Vol. 16 No. 1 (2008), E20-E22